Healthcare in the process of decentralization and corporatization


Organizational, managerial and technical factors now have a definite influence on the structuring of services and on the ways in which services, in particular those related to health, are made available and enjoyed by citizens-users.

For this reason, in the context of the analysis conducted here, the reference to the phenomenon of ‘corporatization’43 could not be omitted which, starting from the beginning of the 1990s, has overwhelmed and modified our National Health Service and consequently also the structures responsible for the protection of mental health.

Health policy during that decade was characterized by a strong push towards decentralization, in the conviction on the part of the legislator that the attribution of decision-making power, and consequent financial responsibilities, at the local level could have made public administrators more responsible for conduct virtuous spending;

these choices were also accompanied by the experimentation of new organizational models that are more competitive between service providers (public or private contracted) with the aim of creating a sort of regulated healthcare market.44

Thus, the “bis reform” and, that is, the reorganization of the years 1992/1993, wanted by the delegated law núm.

421 of 23 October 1992 and implemented with legislative decrees 502 of 1992 and 517 of 1993, had the general objective of guaranteeing citizens access throughout the national territory to a range of predefined health assistance services, ensuring, in the at the same time, compliance with public spending constraints determined prospectively according to the performance of the national economy.

These measures also resulted in the overcoming of the previous organizational system, which passed from a vertically integrated national service model (characterized by the presence of an entity, the State, which intervenes in several phases of the production process of goods and services health), to a mixed model where health goods and services are the work of both the public and the private sector.

The idea that it was necessary to establish a system of competition between public and private institutions in order to improve the quality of the service offered and in compliance with the principle of freedom of choice of the citizen has therefore come to be affirmed, from a subsidiary point of view. 45

The limits 46 of Legislative Decree 502 and 517 are gradually highlighted and are gradually outlined, through debates and comparisons, new health policy orientations, which, towards the end of the 90s, find contextual expression in the National Health Plan for the three-year period 1998- 2000 and in the law 419/98 delegating to the Government for the rationalization of the NHS and in the relative legislative decree.

For this reason with the legislative decree 229 of 1999 it was intended to re-propose, in a rationalized version, the culture, the purposes and the ideals of the 1978 reform: 47 the subsumption of health protection activities within the category of public function implementing the subjective right attributed to the universality of persons, whose freedom and dignity are guaranteed. On the organizational level, the reform outlines an integrated health system where planning responsibilities are attributed to both the central government and local authorities, thus defining a model of administered cooperation.

From this moment, in fact, the Regions contribute to the definition of the National Health Plan48 and in turn the municipalities are responsible for organizing the services, through the definition of the districts, in the most useful way for citizens. In this context, in line with the development of significant forms of social assistance integration, a health governance system is structured in which, albeit in an embryonic way, the role of volunteering and expressions of ethical pluralism are also taken into consideration. -cultural.


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